Pathway Hospice and Palliative Care

“Upon patient record review, 4 of 14 (Patient #1,2,3,5) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: Patient 1: Upon home visit, patient reports she no longer takes CoQ-10 or Bisacodyl 5mg both on the medication list and she is taking Prese vision soft gels twice daily, Potassium 90mg daily, calcium gummies, multivitamin gummies and Acetaminophen 500 mg PRN. She also has a bottle that is non-labeled which she reports is tums which are not present on agency medication list. Corrected on site with medication reconciliation and orders obtained. Patient 2: Upon home visit, wife reports patient is no longer taking tamsulosin 0.4 mg and probiotic blend which remains on agency medication list and caregiver reports Fentanyl patch is now as needed. Agency medication list contains an order for Fentanyl. Staff confirm that Fentanyl patch should have been discontinued with recent medication orders. Corrected on site with medication reconciliation and orders obtained. Patient 3: Upon home visit, son reports patient is taking Eliquis 5mg tablet twice daily and Eliquis is listed once daily on agency medication list and POC. Son administers medications including Miralax PRN, Vit D3 &Vit K2 twice daily which are not included on the agency medication list. Corrected on site with medication orders discontinuing Vit D3 & Vit K2 and obtaining order for Miralax and corrected frequency of Eliquis. Patient 5: Acetaminophen orders for 500mg scheduled 2 tabs twice daily and acetaminophen 650 mg every 6 hours rectally prn with no warning to limit to no more than 4 grams in 24 hour period. Corrected on site with medication orders updated.”

“Upon patient record review, 4 of 14 (Patient #1, 3, 9 and 10) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient 1: The POC 4/14/25 contains an order for Eliquis and there is no evidence of bleeding precautions on the POC. Corrected on site with update made to POC. Patient 3: The POC 8/6/25 contains an order for Eliquis 5mg tablet and there is no evidence of bleeding precautions on the POC. Corrected on site with update made to POC. Patient 9: The POC 7/1/25 contains an order for Eliquis 2.5 mg twice daily on medication profile and there is no evidence of risk for bleeding on the POC. Corrected on site with update made to POC. Patient 10: Initial POC 7/2/25 does not include individualized goals, interventions reflective of patient complaints of dyspnea rating “7” on 1-10 scale and timeframes for completion are not time specific.”

“Upon patient record review, 4 of 14 (Patient # 1, 2, 3, 5) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient 1: Upon home visit, patient reports she no longer takes CoQ-10 or Bisacodyl 5mg both on the medication list and she is taking Prese vision soft gels twice daily, Potassium 90mg daily, calcium gummies, multivitamin gummies and Acetaminophen 500 mg PRN. She also has a bottle that is non-labeled which she reports is tums which are not present on agency POC. Corrected on site with medication reconciliation and updates to POC. Patient 2: Upon home visit, wife reports patient is no longer taking tamsulosin 0.4 mg and probiotic blend which remain on agency medication list and caregiver reports Fentanyl patch is now as needed. Agency medication list contains an order for Fentanyl. Staff confirm that Fentanyl patch should have been discontinued with recent medication orders. Corrected on site with medication reconciliation and updates to POC. Patient 3: Upon home visit, son reports patient is taking Eliquis 5mg tablet twice daily and Eliquis is listed on agency medication list and POC once daily. Son administers medications including Miralax PRN, Vit D3 &Vit K2 twice daily which are not included on agency medication list. Corrected on site with medication reconciliation and updates to POC. Patient 5: Acetaminophen orders for 500mg scheduled 2 tabs twice daily and acetaminophen 650 mg every 6 hrs rectally prn with no warning to limit to no more than 4 grams in 24 hour period. Corrected on site with updates to POC.”

“Upon patient record review, 1 of 14 (Patient #2) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient’s condition requires but no less frequently then every 15 calendar days. Patient 2: Patient has a central access PICC line inserted for chemotherapy prior to admission that was not removed prior to SOC on 11/13/24 SN documents “Discharge planner stated patient will only live a few weeks so they decided against taking out line.” There is no evidence of any further discussion by the IDG members at the meetings. The POC only stated on admission for PICC line plans “Cover with tegadem every two weeks and monitor for infection”.”

“Upon personnel record review, 2 of 14 (Personnel # 7 and 13) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed Personnel 7,13: There is not evidence the aide had direct observation or pseudo-patient evaluation of all types of bathing and hair care by RN. All tasks are on same line of competency evaluation and when evaluating RN is asked about observation, states “I did not know I had to observe each task separately.””

“Upon patient record review, 4 of 14 (Patient # 2,5,7 and 9) did not have evidence in the patient record that hospice aide assignments and duties are: Patient 2: The aide POC on 2/13/25 allows patient choice for bed bath and shower “Give patient choice” Patient has recently only been taking bed baths and is unable to get out of bed. There is no evidence of updated aide POC since admission SOC 11/13/24. Aide POC should include patient’s cognitive ability to make choice of selecting tasks. Patient 5: The aide POC on 2/13/25 allows patient choice for bed bath and shower “Give patient choice” Patient has recently only been taking bed baths and is unable to get out of bed. There is no evidence of updated aide POC since admission SOC 5/12/25. Aide POC should include patient’s cognitive ability to make choice of selecting tasks. Patient 7: The aide POC 6/17/25 allows options for shower or bed bath per patient choice. Updated Aide POC 7/2/25 continues to offer bathing options including shower, bed, or sponge bath. Aide POC should include patient’s cognitive ability to make choice of selecting tasks. Patient 9: The aide POC initiated on 7/2/25 for aide visits 3x weekly at SOC includes bathing. Patient has refused bathing every visit with no updates to POC to not include bathing.”

“Upon patient record review, 1 of 14 (Patient # 2) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient 2: The Comprehensive nursing assessment on 6/27/25 and 7/1/25 the SN documents “Foley Cath 18 Fr last change date 3/25/25. Pt complaining of pressure and pain in groin. He was distended.” Cath was changed at hospital on 6/25 and SN continues to document last change 3/25/25.”